Basic Information
| Provider Information | |||||||||
| NPI: | 1770817256 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LEGACY HOME HEALTH CARE OF SOUTHERN ARIZONA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4996 E MEDITERRANEAN DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203356118 | ||||||||
| FaxNumber: | 5203356736 | ||||||||
| Practice Location | |||||||||
| Address1: | 4996 E MEDITERRANEAN DR | ||||||||
| Address2: | SUITE D | ||||||||
| City: | SIERRA VISTA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856352435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5203356118 | ||||||||
| FaxNumber: | 5203356736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2009 | ||||||||
| LastUpdateDate: | 03/09/2012 | ||||||||
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| AuthorizedOfficialLastName: | SIMONSEN | ||||||||
| AuthorizedOfficialFirstName: | MELISSA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF BUSINESS SERVICES | ||||||||
| AuthorizedOfficialTelephone: | 5203356118 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | Y | Agencies | Home Health |
No ID Information.